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General NPI Number Information
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NPI Number | 1598123481
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Entity Type | Individual
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Provider Name | MARTIN WALSH
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Gender | Male
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 395 W LAKE ST
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City | ELMHURST
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State | IL
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Zip | 60126-1508
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Country | US
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Telephone | 630-530-2988
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Fax |
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Provider Business Mailing Address
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Address Line | 1129 S HERMITAGE AVE ROOM 101
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City | CHICAGO
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State | IL
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Zip | 60612-2607
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Country | US
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Telephone | 312-355-4367
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | 11 815001
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License Number State | IL
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